OBJECTIVE - To review the growth of diabetes as a major health problem for American Indians and Alaska Natives. RESEARCH DESIGN AND METHODS- Pertinent studies of diabetes in Indians previously published are reviewed and compared with current data. RESULTS - Although diabetes rates may vary among different Indian tribes, diabetes has become a widespread health problem. CONCLUSIONS - Our understanding of the natural history of diabetes among Indians has improved, but better strategies to prevent complications and ultimately to prevent diabetes are urgently needed in Indian communities.